The effect of hydrostatic pressure on invasive coronary pressure measurements: Comparison with [15O]H2O-positron emission tomography flow data

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Catheterization and Cardiovascular Interventions Pub Date : 2024-09-11 DOI:10.1002/ccd.31215

Adriaan Wilgenhof MD, Ruurt A. Jukema MD, Roel S. Driessen MD, PhD, Ibrahim Danad MD, PhD, Pieter G. Raijmakers MD, PhD, Niels van Royen MD, PhD, Lokien X. van Nunen MD, PhD, Carlos Collet MD, PhD, Guus A. de Waard MD, PhD, Paul Knaapen MD, PhD

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引用次数: 0

Abstract

Background

Fractional flow reserve (FFR) has emerged as the invasive gold standard for assessing vessel-specific ischemia. However, FFR measurements are influenced by the hydrostatic effect, which might adversely impact the assessment of ischemia.

Aims

This study aimed to investigate the impact of hydrostatic pressure on FFR measurements by correcting for the height and comparing FFR with [¹⁵O]H₂O positron emission tomography (PET)-derived relative flow reserve (RFR).

Methods

The 206 patients were included in this analysis. Patients underwent coronary computed tomography angiography (CCTA), [¹⁵O]H₂O PET, and invasive coronary angiography with routine FFR in every epicardial artery. Height differences between the aortic guiding catheter and distal pressure sensor were quantified on CCTA images. An FFR ≤ 0.80 was considered significant.

Results

The study found a reclassification in 7% of the coronary arteries. Notably, 11% of left anterior descending (LAD) arteries were reclassified from hemodynamically significant to nonsignificant. Conversely, 6% of left circumflex (Cx) arteries were reclassified from nonsignificant to significant. After correcting for the hydrostatic pressure effect, the correlation between FFR and PET-derived RFR increased significantly from r = 0.720 to r = 0.786 (p = 0.009). The average magnitude of correction was +0.05 FFR units in the LAD, −0.03 in the Cx, and −0.02 in the right coronary artery.

Conclusion

Hydrostatic pressure has a small but clinically relevant influence on FFR measurements obtained with a pressure wire. Correcting for this hydrostatic error significantly enhances the correlation between FFR and PET-derived RFR.

Abstract Image

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静水压对有创冠状动脉压力测量的影响：与[15O]H2O-正电子发射断层扫描血流数据的比较

背景部分血流储备（FFR）已成为评估血管特异性缺血的有创金标准。本研究旨在通过校正高度来调查静水压对 FFR 测量的影响，并将 FFR 与[15O]H2O 正电子发射断层扫描（PET）得出的相对血流储备（RFR）进行比较。患者接受了冠状动脉计算机断层扫描（CCTA）、[15O]H2O PET 和有创冠状动脉造影术，并对每条心外膜动脉进行了常规 FFR 检查。在 CCTA 图像上量化了主动脉导引导管和远端压力传感器之间的高度差。研究发现，7% 的冠状动脉被重新分类。值得注意的是，11%的左前降支（LAD）动脉从血流动力学显著性重新分类为非显著性。相反，6% 的左侧环曲（Cx）动脉从非显著性重新分类为显著性。校正静水压效应后，FFR 和 PET 导出 RFR 之间的相关性从 r = 0.720 显著增加到 r = 0.786（p = 0.009）。结论静水压力对使用压力导线获得的 FFR 测量值的影响很小，但与临床相关。对这一静水压误差进行校正可显著增强 FFR 与 PET 导出的 RFR 之间的相关性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Catheterization and Cardiovascular Interventions 医学-心血管系统

CiteScore

5.40

自引率

8.70%

发文量

419

审稿时长

2 months

期刊介绍： Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.